Government 'trying to buy care on the cheap' by not funding private nursing homes

Nursing Homes Ireland Conference 2023 HSE CEO Bernard Gloster addressed the conference on Thursday September 21. 

The Government is “trying to buy care on the cheap” by not funding private nursing homes to meet the challenges of a growing older population, Tadhg Daly of Nursing Homes Ireland (NHI) said.

Mr Daly, speaking during the NHI annual conference in Kilkenny, said while progress has been made towards boosting funding for private and voluntary homes, gaps remain compared with higher funding for public nursing homes.

“There are some changes there, but two things I’d say: One is that it’s not rapid enough, and secondly it’s from a low base,” he said.

“Hiqa has the same set of standards [for public and private] and there is the same residents’ profile. So why is there such a differential? What they’re trying to do in my mind is buy care on the cheap, and there are consequences for that. We’ve seen it with so many closures.” 

Private homes face the same high energy costs as public homes and must meet the same regulations laid out by Hiqa (the Health Information and Quality Authority) as public homes.

'State-sponsored inflation'

Mr Daly welcomed legislation around minimum wage increases and pensions as beneficial for staff but said in effect this is “state-sponsored inflation” and should be funded. 

Funding for all nursing homes is allocated by the National Treatment Purchase Fund (NTPF).

Nursing Homes Ireland Conference 2023 HSE CEO Bernard Gloster (L) standing with Nursing Homes Ireland CEO Tadhg Daly during the conference . Picture: Vicky Comerford

Speaking to the media during the conference, HSE chief executive Bernard Gloster pointed to recent changes in funding structures, led by Mary Butler, the junior minister with responsibility for mental health and older people. 

“Public nursing homes and the HSE — we are the provider of last resort,” he said. 

“Only last Monday when Hiqa ceased the registration of a private provider, it’s the HSE stepped in to take that over.” 

He went on to say: “The majority of private nursing homes have now moved into a one-year negotiating contract position with the NTPF as opposed to longer. And a significant proportion of nursing homes this year, probably about 60%, got a better increase this year than they might have got in previous years, in some cases 6% and 7%.”

Losing staff

The directors of one Cork nursing home said they lost 15% of their staff this year to better-paid jobs in the HSE because their funding does not cover higher wages.

Maryborough Nursing Home has 37 beds and is fully occupied but Director Vipin Karata said funding curtails what they would like to offer residents.

“We have two live music sessions every week, the residents are asking for more live music sessions, that would be helped with the funding,” he said.

“We could do a lot more, like day trips, we could do a lot more with funding. The important thing is Fair Deal doesn’t cover the activity element, because they don’t see it as a vital element, but if there is nothing happening, that is boring.” 

He told the Irish Examiner: “In general we would be able to offer way more options for our residents, now we are careful about everything.” 

'Trapped between NTPF and Hiqa'

He feels the private homes are trapped between the NTPF’s funding limits and the requirements from the health watchdog Hiqa.

“You are in the middle, so you have NTPF not allocating an adequate budget and you have Hiqa on the other side, the regulators,” he said.

“We have no problem following the regulations which we are following, but they are asking for more.”

They have discussed this issue with both bodies, but he said: “We are caught in the middle, we are squeezed.” 

Staffing is a particular issue, as they are unable to match HSE wages or benefits, despite their efforts, he said, adding: 

In the past six months, I lost 15% of my staff to one particular HSE facility in county Cork. 

“15%, because they are paying €1.50 (an hour) extra than us, and we cannot afford it. Plus HSE pension and all the extra benefits.” 

He added: “We are a recruitment agency for the HSE, that’s how we feel.” 

General manager and director Ken O’Callaghan said finances are at the root of challenges facing the sector.

“In the last two years we have seen probably a 20% increase, even a 30% increase in utility costs,” he said, referring to light and heat.

“Our laundry has gone up, they’re obviously just passing on the cost of their light and heat to us. You have all your food going up, it’s just been relentless. And the funding isn’t following suit.” 

He said in general they can see: “You have public homes getting 10% and 20% (funding) increases year on year, whereas private might only get 2% or 3%.

“The disparity in funding is the major concern across the sector because we all have to abide by the same rules and regulations, but we are critically under-funded.”